基于年龄和弥散加权成像（DWI）体积的评分可预测急性缺血性卒中血管内治疗后的不良预后。
A score based on age and DWI volume predicts poor outcome following endovascular treatment for acute ischemic stroke.
作者信息
Liggins John T P, Yoo Albert J, Mishra Nishant K, Wheeler Hayley M, Straka Matus, Leslie-Mazwi Thabele M, Chaudhry Zeshan A, Kemp Stephanie, Mlynash Michael, Bammer Roland, Albers Gregory W, Lansberg Maarten G
机构信息
Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University Medical Center, Stanford, CA, USA.
Department of Radiology, Division of Interventional Neuroradiology, Massachusetts General Hospital, Boston, MA, USA.
出版信息
Int J Stroke. 2015 Jul;10(5):705-9. doi: 10.1111/ijs.12207. Epub 2013 Nov 10.
BACKGROUND AND AIMS
The Houston Intra-Arterial Therapy score predicts poor functional outcome following endovascular treatment for acute ischemic stroke based on clinical variables. The present study sought to (a) create a predictive scoring system that included a neuroimaging variable and (b) determine if the scoring systems predict the clinical response to reperfusion.
METHODS
Separate datasets were used to derive (n = 110 from the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution 2 study) and validate (n = 125 from Massachusetts General Hospital) scoring systems that predict poor functional outcome, defined as a modified Rankin Scale score of 4-6 at 90 days.
RESULTS
Age (P < 0·001; β = 0·087) and diffusion-weighted imaging volume (P = 0·023; β = 0·025) were the independent predictors of poor functional outcome. The Stanford Age and Diffusion-Weighted Imaging score was created based on the patient's age (0-3 points) and diffusion-weighted imaging lesion volume (0-1 points). The percentage of patients with a poor functional outcome increased significantly with the number of points on the Stanford Age and Diffusion-Weighted Imaging score (P < 0·01 for trend). The area under the receiver operating characteristic curve for the Stanford Age and Diffusion-Weighted Imaging score was 0·82 in the derivation dataset. In the validation cohort, the area under the receiver operating characteristic curve was 0·69 for the Stanford Age and Diffusion-Weighted Imaging score and 0·66 for the Houston Intra-Arterial Therapy score (P = 0·45 for the difference). Reperfusion, but not the interactions between the prediction scores and reperfusion, were predictors of outcome (P > 0·5).
CONCLUSIONS
The Stanford Age and Diffusion-Weighted Imaging and Houston Intra-Arterial Therapy scores can be used to predict poor functional outcome following endovascular therapy with good accuracy. However, these scores do not predict the clinical response to reperfusion. This limits their utility as tools to select patients for acute stroke interventions.
背景与目的
休斯顿动脉内治疗评分基于临床变量预测急性缺血性卒中血管内治疗后的功能预后不良。本研究旨在：(a) 创建一个包含神经影像学变量的预测评分系统；(b) 确定该评分系统是否能预测再灌注的临床反应。
方法
使用单独的数据集来推导（来自“理解卒中演变的弥散与灌注成像评估2”研究的110例患者）和验证（来自麻省总医院的125例患者）预测功能预后不良的评分系统，功能预后不良定义为90天时改良Rankin量表评分为4 - 6分。
结果
年龄（P < 0.001；β = 0.087）和弥散加权成像体积（P = 0.023；β = 0.025）是功能预后不良的独立预测因素。斯坦福年龄与弥散加权成像评分基于患者年龄（0 - 3分）和弥散加权成像病变体积（0 - 1分）创建。功能预后不良患者的百分比随斯坦福年龄与弥散加权成像评分的分数显著增加（趋势P < 0.01）。在推导数据集中，斯坦福年龄与弥散加权成像评分的受试者工作特征曲线下面积为0.82。在验证队列中，斯坦福年龄与弥散加权成像评分的受试者工作特征曲线下面积为0.69，休斯顿动脉内治疗评分为0.66（差异P = 0.45）。再灌注是预后的预测因素，但预测评分与再灌注之间的相互作用不是（P > 0.5）。
结论
斯坦福年龄与弥散加权成像评分和休斯顿动脉内治疗评分可用于准确预测血管内治疗后的功能预后不良。然而，这些评分不能预测再灌注的临床反应。这限制了它们作为选择急性卒中干预患者工具的效用。
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